Elsevier

Dermatologic Clinics

Volume 35, Issue 3, July 2017, Pages 365-372
Dermatologic Clinics

Management of Atopic Hand Dermatitis

https://doi.org/10.1016/j.det.2017.02.010Get rights and content

Section snippets

Key points

  • Atopic dermatitis in childhood is associated with occupational hand eczema in adulthood.

  • Patients with filaggrin gene mutations have an increased risk of developing hand eczema but only in the context of atopic dermatitis.

  • It is important to identify and prevent exposure to culprit irritants and allergens that may cause or worsen hand eczema.

  • First-line therapy in patients with atopic dermatitis and hand eczema includes emollients and topical corticosteroids.

Classification and clinical subtypes of hand eczema

HE is divided into various subtypes based on either cause or morphology (Table 1), and several proposals exist in the literature.5, 6, 7 It can be difficult to clinically appreciate such complex classification because there is often no apparent link between the etiologic and morphologic picture and because the morphology of lesions, and even the cause, often change over time in affected patients.5, 7, 8 Interested readers may access a clinically meaningful guideline with photographs showing the

The skin barrier in patients with atopic dermatitis

Patients with AD display skin-barrier impairment due to epidermal filaggrin deficiency caused by exogenous and/or inherited factors. These factors include a low relative humidity, excessive UV exposure, water, detergents, topical corticosteroids, and filaggrin gene (FLG) mutations. Epidermal filaggrin deficiency affects several important pathways, which puts further stress on the barrier.16

The dysfunctional skin barrier makes patients with AD significantly more susceptible to irritant exposure

Epidemiology of hand eczema in patients with atopic dermatitis

In 1985 Rystedt18 found an association between the occurrence of AD in childhood and presence of HE in adulthood. Since then, several studies have confirmed the potent association between these clinical entities, with the highest prevalence of HE in adolescents and young adults.2, 3, 4 Rystedt19 showed that HE is most common in patients with AD aged 25 to 29 years, likely because of a combination of risk factors including domestic and occupational wet work.2, 20

The association between AD and HE

Management of hand eczema in patients with atopic dermatitis

The therapy for HE is similar in patients with and without AD. Moreover, AD on the hands is treated the same way as AD on other parts of the body. Useful guidelines on AD therapy have been published, and the authors refer interested readers to these.33, 34, 35, 36

Regarding the particular management of AHE, it is obviously important to first determine if there is another cause than AD (Box 1). A careful patient interview should, therefore, be performed whereby irritant, allergen, and protein

Medical therapy for patients with atopic dermatitis with hand eczema

The main purposes of medical therapy are to relieve symptoms, suppress inflammation, and improve the skin barrier (Box 2). Therapeutic guidelines vary between countries; however, the variation seems to be small.5, 8 The combination of emollients and topical corticosteroids (TCS) represents the first-line treatment.5, 8, 33, 37, 41 Lipid-rich hypoallergenic emollients improve the skin barrier and are always indicated in patients with AD.5, 8 Moderately potent TCS should be applied daily, often

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    • Skin diseases associated with atopic dermatitis

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      Although AD is the single most important risk factor for HD, exposure to irritants is the most common cause of occupational HD.48 The association is strongest in patients with severe AD, persistent AD on parts of the body other than the hands, and patients with atopic HD since childhood.38, 49 AD has also been associated with more severe HD.38, 50

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    Disclosure Statement: The authors have nothing to disclose.

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